Provider Demographics
NPI:1174537872
Name:OSSEN, JON (DO)
Entity type:Individual
Prefix:DR
First Name:JON
Middle Name:
Last Name:OSSEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2611 COUNTY ROAD 30
Mailing Address - Street 2:
Mailing Address - City:CRAIG
Mailing Address - State:CO
Mailing Address - Zip Code:81625-9639
Mailing Address - Country:US
Mailing Address - Phone:970-826-0150
Mailing Address - Fax:
Practice Address - Street 1:785 RUSSELL ST
Practice Address - Street 2:
Practice Address - City:CRAIG
Practice Address - State:CO
Practice Address - Zip Code:81625-2019
Practice Address - Country:US
Practice Address - Phone:970-824-9411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO36966207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01369966Medicaid
CO804500Medicare ID - Type UnspecifiedCRAIG ER - EMCARE
CO01369966Medicaid